Supporting Numeracy for Nursing in Nursing Education - A best practice case study Facing the Care Challenge RCN Fellows Conference November

Background Nursing numeracy manifestly matters: to patients, to nurses themselves, to their employers, to the public and to nurse educators (Coben 2008) Medication related calculation – A most common exemplar for nursing numeracy - incorrect calculation of medication dosage can result in harm to patients and to reputation of the profession.

Nursing and Midwifery Council Regulatory Position Clear and specific focus upon ‘ public protection through professional regulation ’ Use of statutory control over the approval and monitoring of nursing education to ensure appropriate professional standards Leaves the details of outcome measures to individual universities to decide

How can a benchmark assessment help students and teachers? Students in nursing must be: supported to learn prepared for safe practice ultimately employable Variation in outcome measures for numeracy mean students learn to succeed by numbers, playing 'dot to dot' to achieve the required hurdles - but may struggle to see a whole picture

Study aims 1. Initial aim To evaluate empirical evidence of the reliability and convergent validity of a computer based learning and assessment tool of medicine dosage calculation ability and determine learner perceived acceptability of the assessment tools in relation to authenticity, relevance, fidelity and value. 2. Subsequent aim To work towards establishing a recognised benchmark of best practice in numeracy for nursing by determining professionally perceived acceptability of exemplar content of the assessment tool in relation to authenticity, relevance, fidelity and value.

The computer activity

Evaluation

Where are we now? Project completed and findings launched in early 2009 and has been published extensively through conference and journals.. The theoretical underpinning and findings of the work havecontributed significantly to the New NMC Standards for Practice in the identification of ESC requirements and in respect of a clearer definition of nursing numeracy and the guidance and also in supporting need for practice and theoretical assessment The exemplar assessment tool is on the website and is well received by professionals at presentations such as this. However, further evaluation is needed and welcome. More work needs to be done to define the benchmark as professionally acceptable in other fields of practice More work is needed which tests out other assessments against this tool and considers global acceptability

NMC Standards for pre-registration nursing education Guidance related to numerical assessment Some ESCs identify the baseline skills needed to calculate medicines, nutrition, fluids and other areas where there is a need to use numbers. These appear in ESCs 9, 27, 28, 29, 31, 32, 33, 36 and 38. They are marked with an asterix (*). Providers should incorporate all these health related numerical assessments, designed to test numeracy skills, into learning outcomes and assessment strategies. The focus should be on demonstration of competence and confidence with regard to judgements on whether to use calculations in a particular situation and, if so, what calculations to use, how to do it, what degree of accuracy is appropriate, and what the answer means in relation to the context. Providers can incorporate these health related numerical elements into their own learning outcomes and assessment strategies and should use the ESCs to underpin the nature and content of the assessment, including whether to assess through simulation. They should decide on their own pass mark and how many attempts are allowed in order to reach the first and second progression points. After the second progression point, and by the point of entry to the register, the ESCs should help programme providers decide the nature and content of numerical assessments where a 100 percent pass mark is required. Assessment should reflect competence across the full range of complexity, the different delivery modes and technical measurement issues. This may take place in a combination of settings, including computer lab and simulated practice, but must include assessment in the practice setting. The number of attempts should be decided by the programme provider. NMC Essential Skills Clusters (2010) 16 September 2010 Page 104 of 152

NMC Essential skills cluster: Medicines management First progression point Is competent in basic medicines calculations relating to: tablets and capsules liquid medicines injections including: unit dose sub and multiple unit dose SI unit conversion Complex calculations Entry to the register Is competent in the process of medication related calculation in nursing field involving: tablets and capsules liquid medicines injections IV infusions including: unit dose sub and multiple unit dose SI unit conversion Complex calculations

Meet the Team Diana Coben BA, PhD, DipACE, FRSA, FHEA Professor of Adult Numeracy, Department of Education and Professional Studies, King’s College London Carol Hall RN, RNT, PhD, BSc (Hons) Dip N, PG Dip ResM, PGDip Ad/Ed Associate Professor, School of Nursing, University of Nottingham Meriel Hutton RN, RNT, PhD, BA, Cert Ed, Dip N Independent Consultant and Visiting Senior Research Fellow, Department of Education and Professional Studies, King’s College London David Rowe BEd (Hons), MSc, PhD, FACSM, FRC Reader in Exercise Science, Department of Sport, Culture and the Arts, University of Strathclyde Mike Sabin RGN, BSc (Hons), MSc, PG Cert Programme Director, NHS Education for Scotland Keith Weeks RN, RNT, PhD, BSc (Hons), BEd, Dip N., FHEA Reader in Health Professional Education, Faculty of Health, Sport & Science, University of Glamorgan Norman Woolley RN, RNT, MSc, MN, Dip N, PGCE Head of Learning & Teaching, Faculty of Health, Sport & Science, University of Glamorgan